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Florida Department of Agriculture and Consumer Services Division of Consumer Services

SMALL CHARITABLE ORGANIZATIONS/SPONSORS REGISTRATION APPLICATION Solicitation of Contributions Act Chapter 496, Florida Statutes Rule 5J-7.004, Florida Administrative Code

NO FEE REQUIRED

1-800-HELP-FLA (435-7352) 850-410-3800 Calling Outside Florida www.800helpfla.com • 850-410-3804 Fax

ADAM H. PUTNAM COMMISSIONER

All documents and attachments submitted with this application are subject to public review pursuant to Chapter 119, F.S.

Business Information Legal Name:

The Tina Dailey Foindation

FEIN:

81-3038719

Business Phone:

305-204-9907

Business Address:

5288 SW 69 Pl Miami Florida 33155

Mailing Address:

6800 SW 40 Street . Box 273 Miami Florida 33155

Email Address:

[email protected]

Website Address:

Thetinadaileyfoundation.org

Fictitious Names**

Not Applicable

**All fictitious names must be registered with the Division of Corporations. If business is a corporation then 'Name' is the legal name of the business as listed with the Division of Corporations. You must list all names under which you intend to do business. Business Details Month/Day fiscal year ends: Organization's Internal Revenue Service Status: Uploads Attached:

12/18 501(c)(1)

Yes

Attached Documents

1. Name: 0716FA7B-6049-45AB-9EE5-2C6DC2353F4A.jpeg Type: Exemption Determination Letter Purpose of the Organization: To serve as a tribute to Tina Dailey by raising alcohol and drug abuse awareness. Supporting families, connecting people to recovery resources and educating the community on effective prevention efforts to battle stigma and defeat the disease of addiction. Purpose for which the contributions are used:

Education, awareness and removing the stigma. Mental health recovery treatment with a major reputable program including screenings. Personnel Information Officer 1

Name:

Vilma M Dailey

Title:

President

Phone:

305-778-9785

Address:

5288 SW 69 Pl Miami Florida 33155 Criminal History Questions

1.

Is this person exempt from Public Records? [s. 119.071(4), F.S.] No

2.

Has this person been convicted of, found guilty of, pled guilty or nolo contendere to, or been incarcerated within the last 10 years as a result of having previously been convicted of, or found guilty of, or pled guilty or nolo contendere to, any felony, or crime involving fraud, theft, larceny, embezzlement, fraudulent conversion, misappropriation of property, or any crime arising from the conduct of a solicitation for a charitable organization or sponsor within the last 10 years? [s. 496.405(2)(d)5, F.S.] No

3.

Has this person been enjoined from violating any law relating to a charitable solicitation? [s. 496.405(2)(d)6, F.S.] No

Officer 2

Name:

Vilma M Dailey

Title:

In Charge of Distribution President

Phone:

305-778-9785

Address:

5288 SW 69 Pl Miami Florida 33155 Criminal History Questions

1.

Is this person exempt from Public Records? [s. 119.071(4), F.S.] No

2.

Has this person been convicted of, found guilty of, pled guilty or nolo contendere to, or been incarcerated within the last 10 years as a result of having previously been convicted of, or found guilty of, or pled guilty or nolo contendere to, any felony, or crime involving fraud, theft, larceny, embezzlement, fraudulent conversion, misappropriation of property, or any crime arising from the conduct of a solicitation for a charitable organization or sponsor within the last 10 years? [s. 496.405(2)(d)5, F.S.] No

3.

Has this person been enjoined from violating any law relating to a charitable solicitation? [s. 496.405(2)(d)6, F.S.] No

Officer 3

Name:

Vilma M Dailey

Title:

In Charge of Solicitation

Phone:

305-778-9785

Address:

5288 SW 69 pl Miami Florida 33155 Criminal History Questions

1.

Is this person exempt from Public Records? [s. 119.071(4), F.S.] No

2.

Has this person been convicted of, found guilty of, pled guilty or nolo contendere to, or been incarcerated within the last 10 years as a result of having previously been convicted of, or found guilty of, or pled guilty or nolo contendere to, any felony, or crime involving fraud, theft, larceny, embezzlement, fraudulent conversion, misappropriation of property, or any crime arising from the conduct of a solicitation for a charitable organization or sponsor within the last 10 years? [s. 496.405(2)(d)5, F.S.] No

3.

Has this person been enjoined from violating any law relating to a charitable solicitation? [s. 496.405(2)(d)6, F.S.] No Financial Statement

Fiscal year ending:

11/15/2017

Financial statement source:

990 EZ and Schedule O

Uploads Attached:

Yes

Attached Documents

1. Name: image.jpg Type: Financial Information Supporting Documents(List of Sources and Amounts) Application Questionnaire Did the charitable organization or sponsor receive $25,000 or more in total revenue during the No immediately preceding fiscal year?: Are the fundraising activities of the charitable organization or sponsor carried on by any compensated volunteers, members, or officers ?:

No

Are any part of the assets or income of the organization or sponsor inured to the benefit of or No paid to any officer or member?: Does the charitable organization or sponsor utilize a professional fundraising consultant, professional solicitor, or commercial co-venture?:

No

Preparer Information First Name:

Vilma

Last Name:

Dailey

Phone Number:

305-778-9785 Signature Information

*

I declare under penalty of perjury that all of the information provided in this application and in any exhibits attached hereto, is true and correct.

and further state as follows:

*

I certify that I am authorized to complete this application and the information provided is true and accurate. The above information is provided for the purpose of complying with the provisions of

Chapter 496, Florida Statutes. *

I certify that the above named charitable organization or sponsor has less than $25,000 in total revenue (including contributions).

*

I certify that the fundraising activities of the above named charitable organization or sponsor are carried on by volunteers, members, or officers who are not compensated and no part of the assets or income of the organization or sponsor inures to the benefit of or is paid to any officer or member of the above named charitable organization or sponsor.

*

I certify that the above named charitable organization or sponsor does not utilize a professional fundraising consultant, professional solicitor, or commercial co-venturer.

Signature Name:

Vilma Dailey

Signature Date:

10/15/2018